Rethinking the All-or-Nothing Definition of Success in Addiction Recovery

If a person struggling with alcohol use cuts their heavy drinking days by 75 percent but isn’t able to stop drinking altogether, a not uncommon outcome after treatment, does that count as success or failure?

In the recovery community, anything less than total abstinence has traditionally been placed in the “failure” column. One drink and you’re back to zero.

But there’s growing support in the addiction treatment community for looking beyond the all-or-nothing mindset and recognizing that addiction improves on a continuum, just as other chronic illnesses do. If someone with heart disease or diabetes records a 75 percent improvement, it’s a cause for celebration. Only with addiction is a figure such as this a disappointment.

For the problem drinker, the reality is that slips and lapses are a common part of the process of getting better. In fact, few will make it through the first year after treatment without a drink. While the addiction treatment community agrees that the safest outcome is continuous sobriety, there is also recognition that every success in limiting drinking adds quality to a person’s life and can help create a foundation for further success.

Consider those admitted to alcohol treatment studies. They normally start with between 15-20 heavy drinking days per month. By the end of acute treatment, those who have not been able to stop drinking altogether have usually managed to decrease the number of drinking days to around 2-6 days per month. Technically, they’re not sober, but there can be sometimes dramatic benefit from the change. Most report they feel better, are able to work more effectively and see improvement in their relationships.

Getting away from an insistence on abstinence also allows the treatment community to engage people who might otherwise be left out of the process. Some, for example, may be prepared to change their drinking pattern before they are ready to become continuously abstinent; of these, many can eventually be helped into long-term sobriety. For others, cutting down on their drinking will be as good as it gets. This may not be the best or the safest outcome, but it does count as a substantial improvement over the alternative, not only for themselves but for everyone in their orbit.

Not everyone agrees that taking the focus off abstinence is a positive. Some see it as enabling drinkers rather than helping them move toward sobriety. Those who support the mindset, however, say that helping a person reduce their drinking days per month should always count as progress, and it may be the first step toward helping them get the number down to zero.

Some, of course, find strength and inspiration in the abstinence-based philosophy of 12-step groups such as Alcoholics Anonymous. And choosing this route can help minimize any associated risks. But the insistence on abstinence can leave behind a sizable group that finds itself unable to commit. They may be best helped by a mental health model that focuses more on behavioral changes and on reducing use rather than on eliminating it. New medications can aid in the process. Naltrexone, for example, has been shown to help decrease the number of heavy drinking days in some. The effect is generally modest, but it can be another tool in helping drinkers limit the impairment in their lives.

In these cases, the focus shifts from “Are you abstinent” to “Is your life better?” If the drinker can answer “yes,” they then recognize what they’ve gained from each day without drinking and may be inspired to work toward more.

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